Neurotic excoriations: a diagnosis of exclusion

Patients with psychiatric disease may use the skin as a means of communication during times of increased emotional distress. Furthermore, a high incidence of skin disorders among patients with a primary psychiatric condition, including depression, schizophrenia, and anxiety, has been demonstrated, with neurotic excoriation being one of the most commonly diagnosed. Despite the strong association and incidence of psychogenic excoriation in patients with a primary psychiatric disorder, it is important for primary care physicians and dermatologists alike to realize that these patients may have true dermatological disease. The authors present a 53-year-old woman with past medical history significant for schizophrenia, depression, hepatitis C, and diabetes mellitus type II, who was transferred from an outside hospital secondary to anemia in association with diffuse skin lesions. Although she adamantly denied self-inducing the skin lesions, she was diagnosed with neurotic excoriations by primary care and specialty care physicians on three different occasions. After a thorough workup during this admission, the patient was diagnosed with bullous pemphigoid.